Healthcare Provider Details

I. General information

NPI: 1730010570
Provider Name (Legal Business Name): STACEY AKEMI HATA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 OAKDALE AVE
SAN FRANCISCO CA
94124-2323
US

IV. Provider business mailing address

1595 QUINTARA ST RM 5
SAN FRANCISCO CA
94116-1273
US

V. Phone/Fax

Practice location:
  • Phone: 415-713-0755
  • Fax:
Mailing address:
  • Phone: 415-713-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT5766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: